INSU07019 2022 Practice of Claims and Loss Adjusting 2 (Practice)

Demonstrate a comprehensive understanding of the claims environment.

Demonstrate the progression of a claim from notification to investigation to settlement and dispute resolution with particular reference to the professionals, regulation and documentation involved.

Demonstrate critical understanding on how indemnity is applied and measured.

Demonstrate a critical understanding of the special considerations relevant to third party claims.

Act effectively under guidance in a peer relationship with qualified practitioners; learn to act in variable unfamiliar learning contexts managing tasks independently, professionally and ethically.

This module will be delivered through self-directed learning with the support of a supervisor and mentor in the student's workplace. This module complements "The Practice of Claims and Loss Adjusting 1" module and allows the student to integrate their academic knowledge gained into a practical work-based setting in the completion of a number of case studies and on-the-job tasks. The student will have ample choice to enable them to pick an agreed number of case studies and tasks from the work-based syllabus. The student should focus on case studies that are appropriate to their working environment. The completed case studies will be submitted through the learning management system having been signed off by their supervisor. The completed case studies will be reviewed by IT Sligo's academic programme leader.

There are specific requirements which must be met by the student in completing the experience-based syllabus. The work-based supervisor is required to validate that the case studies and tasks meet the attainment of the learning outcomes of the module. Specific criteria are provided for each of the case study areas. The student must answer the relevant questions posed in the prescribed format. The work-based supervisor will assess the case study/task on a pass / fail basis and the completed case studies (with the supervisor's report) are uploaded to the learner management system by the student. The case studies will not be considered/accepted as complete if they are not submitted with the supervisor's signature/report.

This module will be assessed 100% by continuous assessment.

This module has been designed to complement the ‘Practice of Claims and Loss Adjusting 1' module. The student will relate the topics covered in the theory module to their workplace environment and will work on these learnings in a business context.

This assessment examines the student's understanding and application of knowledge. The case studies require students to link pieces of information together in a cause-and-effect relationship and apply their knowledge and/or understanding to a given set of circumstances.

The answers will involve an essay-type response.

If the work-based supervisor fails to sign-off on the student's submission, the student has a maximum of 3 opportunities to submit their work.

A submission will not be accepted or considered complete if the work-based supervisor has not signed off on the work.

LO1 THE CLAIMS ENVIRONMENT

• Outline the importance of effective claims handling procedures, the main stages in the development of a claim and the important elements of the claims process.
• Explain the differences between first party claims and third party claims. ·
• Demonstrate the effect of data protection legislation and the Central Bank Consumer Protection Code (CPC) on the claims function. ·
• Explain how insurance fraud arises and the measures used to prevent, detect and combat fraud.

LO2 CLAIMS NOTIFICATION ·

• Explain the typical claims notification process, including the information gathered by insurers and why this information is important. 
• Explain the duties of the insured after a loss. 
• Outline how policyholders and insurers can mitigate the effects of a loss. 
• Describe the claims documentation that an insurer may require to support a claim and outline the role of intermediaries in claims notification.
• Explain the importance and uses of claims reserves and describe the reserving process.

LO2 CLAIMS VERIFICATION

• Describe the initial checks that insurers undertake to validate a claim and how the policy structure is used during this process, and demonstrate how the basis of cover can affect a claim.
• Explain the legal principles of insurable interest and utmost good faith and demonstrate their relevance to the handling of claims.
• Explain the legal principle of proximate cause and demonstrate its relevance to the handling of claims.

LO2 CLAIMS INVESTIGATION

• Explain the purpose of claims investigation, including the role of the claims handler and the scope of desktop claims handling.
• Explain the role of loss adjusters, loss assessors, claims investigators, brokers and other professionals involved in claims investigations, including the potential outcomes of an investigation.

LO2 CLAIMS SETTLEMENT

• Explain the ways that insurers settle first party and third party claims.
• Explain and apply the principles of salvage, abandonment, subrogation and contribution.
• Outline the impact of reinsurance recoveries in the claims process.
• Describe the role of the Financial Services Ombudsman (FSO), and the processes of arbitration and mediation in dispute resolution.

LO3 INDEMNITY: HOW MUCH WILL THE POLICY PAY:

• Explain the principle of indemnity and demonstrate the factors that limit and extend the operation of this principle.
• Apply the principle of indemnity to the main classes of general insurance.

LO4 THIRD PARTY CLAIMS - LEGAL CONSIDERATIONS

• Outline the legal basis of a third party claim and the available remedies in tort.
• Explain the main considerations when assessing the quantum of a personal injury claim.
• Demonstrate the role of the Personal Injuries Assessment Board (PIAB).
• Describe the defences in tort and explain the other issues that may reduce the cost of a third party claim.
• Outline the role of the Irish courts system in the claims process including civil and court procedure, and demonstrate the impact of statutory limitation periods on liability claims.